burns

by nadine on May 23, 2011

Severe burns are a worldwide problem especially in rural areas. Aside from the immediate loss of life, the potential for long-term disability is great. In subSaharan Africa, young children under the age 15, lose seven times the number of productive years from fires than from war.

In South Asia, more years of healthy life are lost for people between the ages of 0-29 due to fire (burn injury) than from TB, malaria, or HIV/AIDs. In this region, as distinct from the rest of the developing world, women are disproportionally more affected than boys, with almost 72% of these burn injuries afflicting young girls and women.

These estimates are conservative at best.

Most general surgeons or clinical doctors with some surgical training have the skills to save lives- i.e., the acute resuscitation and basic burn wound care required for the patient with a significant burn injury. But often, the more subtle issues relating to maintenance of function during the healing stages are not considered by providers without plastic surgical expertise. Without proper attention to the need for splints (hand burns) or early burn excision and skin grafting (for large burns) the healing process can result in significant disability. The resulting burn scar contractures (which can occur despite even the best of care) can result in significant disability. And once the contracture has formed, it can be difficult to correct.

Some actual patients:

Patient 1: A 3 year old boy who burned the palm of his hand over a year earlier when he grabbed a hot pot. The burn was not life-threatening, but due to lack of treatment, his fingers are now contracted and literally stuck into his palm- this child’s hand is essentially useless.

Patient 2: A 9 year old girl who suffered severe burns to the back of her hand as a young child. Again this was not a life threatening burn, but the skin on the back of her hand was allowed to heal on its own and the result: very tight scars which did not grow as she has grown. She now has a severely disfigured and dysfunctional hand.

How these patients can be helped:

Prevention is key. It doesn’t take fancy equipment or special skills to prevent these terrible outcomes. The following three interventions can dramatically improve patient outcomes.

Application of splints while the burn wounds are healing will help to prevent contractures. You want to keep the hand and fingers in neutral position (wrist in slight extension, MP joints in flexion, and IP joints straight).

In addition, regular physical therapy during the healing process will keep the joints mobile. Encourage the patient/patient’s family to help them exercise their fingers several times a day.

And particularly for burns that cross joint creases, early excision of the burned tissue followed by skin grafting can prevent or lessen the disability than can results from these injuries.